<?php $this->session->unset_userdata();  ?>
<!--personal details starts-->
<div class="personal_details">
    <!--scroll container starts-->  
        <div id="description">
            <!--form starts-->
            <?php echo form_open(base_url().BASE.'join_as_submit_detail_continue', array('id' => 'join_as_form_institution_detail', 'autocomplete' => 'off')); ?>
                
                    <div class="form_fields">
                        <div class="textfield_box">
                         <input autocomplete="off" onBlur="this.value=jQuery.trim(this.value)"  type="email" name="email"  value="<?php if(isset($input_data['email'])) { echo strip_tags($input_data['email']); }?>" placeholder="Email" id="email" class="detailed_textfield2 content_pink"> 
                         </div>
                         
                         <div class="textfield_box">
                         <input autocomplete="off" onBlur="this.value=jQuery.trim(this.value)"  type="password" id="password" value="<?php //if(isset($input_data['password'])) { echo $input_data['password']; }?>" name="password" placeholder="Password" class="detailed_textfield2 content_blue">
                         </div>
                         
                          <!--<div class="textfield_box">
                        <input type="password" id="reconfirming_password" value="" name="reconfirming_password" placeholder="Reconfirming password" class="detailed_textfield4 content_blue">
                         </div>-->
                         <div class="textfield_box">
                            <input type="text" name="first_name" onBlur="this.value=jQuery.trim(this.value)"  value="<?php if(isset($input_data['first_name'])) { echo strip_tags($input_data['first_name']); }?>" placeholder="First name" id="first_name" class="detailed_textfield4 content_pink"> 
                         <input type="text" id="last_name" onBlur="this.value=jQuery.trim(this.value)" value="<?php if(isset($input_data['last_name'])) { echo $input_data['last_name']; }?>" name="last_name" placeholder="Last name" class="detailed_textfield4 content_blue">
                        </div>
                        <div class="clear"></div>
                        <div class="textfield_box">
                            <input type="text" name="Shortname" onBlur="this.value=jQuery.trim(this.value)" id="Shortname" value="<?php if(isset($input_data['Shortname'])) { echo strip_tags($input_data['Shortname']); }?>" placeholder="Shortname" class="detailed_textfield2 content_blue">
                        </div>
                        <div class="clear"></div>
                        <div class="textfield_box">
                            <textarea name="tagline" id="tagline" onBlur="this.value=jQuery.trim(this.value)" placeholder="Tagline" class="content_blue detailed_textfield2"><?php if(isset($input_data['tagline'])) { echo strip_tags($input_data['tagline']); }?></textarea>
                        </div>
                        
                        <div class="clear"></div>
                        
                        <div class="textfield_box">
                            <input type="text" name="Founded_in" onBlur="this.value=jQuery.trim(this.value)" id="Founded_in" value="<?php if(isset($input_data['Founded_in'])) { echo strip_tags($input_data['Founded_in']); }?>" placeholder="Founded in" class="detailed_textfield2 content_blue">
                        </div>
                        
                        <div class="textfield_box">
                            <div class="country_form detailed_textfield content_pink"><?php if(isset($input_data['country']) && $input_data['country']!='')echo strip_tags($input_data['country_1']);else echo 'Country'; ?></div>
                        </div>
                        <div class="clear"></div>
                         
                        <div class="textfield_box">
                            <div class="state_form detailed_textfield content_pink"><?php if(isset($input_data['state']) && $input_data['state']!='')echo strip_tags($input_data['state']);else echo 'State'; ?></div>
                            <div class="city_form detailed_textfield content_blue">  <?php if(isset($input_data['city']) && $input_data['city']!='')echo strip_tags($input_data['city']);else echo 'City'; ?></div>
                            <!--<input type="text" name="city" id="city" value="" readonly placeholder="City" class="detailed_textfield content_pink">
                            <input type="text" name="state" id="state" value="" readonly placeholder="State" class="detailed_textfield content_blue">-->
                            <input type="text" name="postal_code" onBlur="this.value=jQuery.trim(this.value)" id="postal_code" value="<?php if(isset($input_data['postal_code'])) { echo strip_tags($input_data['postal_code']); }?>" placeholder="Postal Code" class="detailed_textfield content_pink">
                            <div class="clear"></div>
                        </div>
                        <div class="clear"></div>
                        
                        <div class="textfield_box">
                            <textarea name="Address" id="Address" onBlur="this.value=jQuery.trim(this.value)" placeholder="Address" class="detailed_textfield2 content_pink"><?php if(isset($input_data['Address'])) { echo strip_tags($input_data['Address']); }?></textarea>
                        </div>
                        <div class="clear"></div>
                        
                        <div class="textfield_box">
                            <input type="text" name="phone_number1" onBlur="this.value=jQuery.trim(this.value)" id="phone_number1" value="<?php if(isset($input_data['phone_number1'])) { echo strip_tags($input_data['phone_number1']); }?>" placeholder="Phone Number 1" class="detailed_textfield2 content_blue">
                        </div>
                        <div class="clear"></div>
                        <div class="textfield_box">
                            <input type="text" name="phone_number2" onBlur="this.value=jQuery.trim(this.value)" id="phone_number2" value="<?php if(isset($input_data['phone_number2'])) { echo strip_tags($input_data['phone_number2']); }?>" placeholder="Phone Number 2" class="detailed_textfield2 content_blue">
                        </div>
                        <div class="clear"></div>
                        <div class="textfield_box">
                            <input type="text" name="phone_number3" onBlur="this.value=jQuery.trim(this.value)" id="phone_number3" value="<?php if(isset($input_data['phone_number3'])) { echo strip_tags($input_data['phone_number3']); }?>" placeholder="Phone Number 3" class="detailed_textfield2 content_blue">
                        </div>
                        <div class="clear"></div>
                       
                       <div class="textfield_box">
                            <input type="text" name="Branches1" onBlur="this.value=jQuery.trim(this.value)" id="Branches1" value="<?php if(isset($input_data['Branches1'])) { echo strip_tags($input_data['Branches1']); }?>" placeholder="Branches 1" class="detailed_textfield2 content_blue">
                        </div>
                        <div class="clear"></div>
                        <div class="textfield_box">
                            <input type="text" name="Branches2" onBlur="this.value=jQuery.trim(this.value)" id="Branches2" value="<?php if(isset($input_data['Branches2'])) { echo strip_tags($input_data['Branches2']); }?>" placeholder="Branches 2" class="detailed_textfield2 content_blue">
                        </div>
                        <div class="clear"></div>
                        <div class="textfield_box">
                            <input type="text" name="Branches3" onBlur="this.value=jQuery.trim(this.value)" id="Branches3" value="<?php if(isset($input_data['Branches3'])) { echo strip_tags($input_data['Branches3']); }?>" placeholder="Branches 3" class="detailed_textfield2 content_blue">
                        </div>
                        <div class="clear"></div>
                       
                        <div class="textfield_box">
                            <textarea name="About_Us" id="About_Us" onBlur="this.value=jQuery.trim(this.value)" placeholder="About Us" class="detailed_textfield2 content_pink"><?php if(isset($input_data['About_Us'])) { echo strip_tags($input_data['About_Us']); }?></textarea>
                        </div>
                        <div class="clear"></div>
                        
                        <div class="textfield_box">
                            <input type="text" name="Institution_Head" onBlur="this.value=jQuery.trim(this.value)" id="Institution Head" value="<?php if(isset($input_data['Institution_Head'])) { echo strip_tags($input_data['Institution_Head']); }?>" placeholder="Institution Head" class="detailed_textfield2 content_blue">
                        </div>
                        <div class="clear"></div>
                        
                         <div class="textfield_box">
                            <input type="text" name="Management_Team1" onBlur="this.value=jQuery.trim(this.value)" id="Management_Team1" value="<?php if(isset($input_data['Management_Team1'])) { echo strip_tags($input_data['Management_Team1']); }?>" placeholder="Management Team" class="detailed_textfield2 content_blue">
                        </div>
                        <div class="clear"></div>
                        
                         <div class="textfield_box">
                            <input type="text" name="Management_Team2" onBlur="this.value=jQuery.trim(this.value)" id="Management_Team2" value="<?php if(isset($input_data['Management_Team2'])) { echo strip_tags($input_data['Management_Team2']); }?>" placeholder="Management Team" class="detailed_textfield2 content_blue">
                        </div>
                        <div class="clear"></div>
                        
                         <div class="textfield_box">
                            <input type="text" name="Management_Team3" onBlur="this.value=jQuery.trim(this.value)" id="Management_Team3" value="<?php if(isset($input_data['Management_Team3'])) { echo strip_tags($input_data['Management_Team3']); }?>" placeholder="Management Team" class="detailed_textfield2 content_blue">
                        </div>
                        <div class="clear"></div>
                        
                        <div class="textfield_box">
                            <input type="text" name="Board_Affiliation1" onBlur="this.value=jQuery.trim(this.value)" id="Board_Affiliation1" value="<?php if(isset($input_data['Board_Affiliation1'])) { echo strip_tags($input_data['Board_Affiliation1']); }?>" placeholder="Board Affiliation" class="detailed_textfield2 content_blue">
                        </div>
                        <div class="clear"></div>
                        
                         
                        <div class="textfield_box">
                            <input type="text" name="Board_Affiliation2" onBlur="this.value=jQuery.trim(this.value)" id="Board_Affiliation2" value="<?php if(isset($input_data['Board_Affiliation2'])) { echo strip_tags($input_data['Board_Affiliation2']); }?>" placeholder="Board Affiliation" class="detailed_textfield2 content_blue">
                        </div>
                        <div class="clear"></div>
                        
                        
                        <div class="textfield_box">
                            <input type="text" name="Board_Affiliation3" onBlur="this.value=jQuery.trim(this.value)" id="Board_Affiliation3" value="<?php if(isset($input_data['Board_Affiliation3'])) { echo strip_tags($input_data['Board_Affiliation3']); }?>" placeholder="Board Affiliation" class="detailed_textfield2 content_blue">
                        </div>
                        <div class="clear"></div>
                        
                         <div class="textfield_box">
                            <input type="text" name="Classes" onBlur="this.value=jQuery.trim(this.value)" id="Classes" value="<?php if(isset($input_data['Classes'])) { echo strip_tags($input_data['Classes']); }?>" placeholder="Classes" class="detailed_textfield2 content_blue">
                        </div>
                        <div class="clear"></div>
                         
                          <div class="textfield_box">
                            <textarea name="Amenities" id="Amenities" onBlur="this.value=jQuery.trim(this.value)" placeholder="Amenities" class="detailed_textfield2 content_pink"><?php if(isset($input_data['Amenities'])) { echo strip_tags($input_data['Amenities']); }?></textarea>
                        </div>
                        <div class="clear"></div>
                        
                        <div class="textfield_box">
                            <textarea name="Recommendations" onBlur="this.value=jQuery.trim(this.value)" id="Recommendations" placeholder="Recommendations" class="detailed_textfield2 content_pink"><?php if(isset($input_data['Recommendations'])) { echo strip_tags($input_data['Recommendations']); }?></textarea>
                        </div>
                        <div class="clear"></div>
                        
                         <div class="textfield_box">
                            <textarea name="Associations" onBlur="this.value=jQuery.trim(this.value)" id="Associations" placeholder="Associations" class="detailed_textfield2 content_pink"><?php if(isset($input_data['Associations'])) { echo strip_tags($input_data['Associations']); }?></textarea>
                        </div>
                        <div class="clear"></div>
                        
                         <div class="textfield_box">
                            <textarea name="Tournaments" onBlur="this.value=jQuery.trim(this.value)" id="Tournaments" placeholder="Tournaments" class="detailed_textfield2 content_pink"><?php if(isset($input_data['Tournaments'])) { echo strip_tags($input_data['Tournaments']); }?></textarea>
                        </div>
                        <div class="clear"></div>
                        
                         <div class="textfield_box">
                            <textarea name="Achievements" onBlur="this.value=jQuery.trim(this.value)" id="Achievements" placeholder="Achievements" class="detailed_textfield2 content_pink"><?php if(isset($input_data['Achievements'])) { echo strip_tags($input_data['Achievements']); }?></textarea>
                        </div>
                        <div class="clear"></div>
                        
                        <div class="submit_button">
                            <input type="button" value="" name="personal_detail" id="personal_detail">
                        </div>
                    </div>
                    <!--select school starts-->
                    <div class="select_stateform content_pink">
                            <div class="go_back">
                                <a href="javascript:void(0);" title="<?php echo $static_info['go_back'] ?>"> </a>
                            </div>
                            <input type="text" id="state" onBlur="this.value=jQuery.trim(this.value)" maxlength="100" name="state" placeholder="State" value="<?php if(isset($input_data['state']))echo strip_tags($input_data['state']); ?>" class="textfield content_pink" data-autosize-input='{"space":10}' autocomplete="off">
                            <?php echo $static_text['we_are_located']; ?>
                            <input type="hidden" id="state_1" name="state_1" value="<?php if(isset($input_data['state_1']))echo strip_tags($input_data['state_1']); ?>">
                            <div class="result_not_found" style="display:none;"><a href="javascript:void(0);">
                                <img src="<?php echo SKIN_URL_IMAGE;?>/submit.png"></a>
                            </div>
                            <br>
                            <div id="state_result">
                            </div>
	                  </div>
                       <!--select country starts-->
                    <div class="select_countryform content_pink">
                            <div class="go_back">
                                <a href="javascript:void(0);" title="<?php echo $static_info['go_back'] ?>"> </a>
                            </div>
                            <input type="text" id="country" onBlur="this.value=jQuery.trim(this.value)" maxlength="100" name="country" placeholder="Country" value="<?php if(isset($input_data['country']))echo strip_tags($input_data['country']); ?>" class="textfield content_pink" data-autosize-input='{"space":10}' autocomplete="off">
                            <?php echo $static_text['we_are_located']; ?>
                            <input type="hidden" id="country_1" name="country_1" value="<?php if(isset($input_data['country_1']))echo strip_tags($input_data['country_1']); ?>">
                            <div class="result_not_found" style="display:none;"><a href="javascript:void(0);">
                                <img src="<?php echo SKIN_URL_IMAGE;?>/submit.png"></a>
                            </div>
                            <br>
                            <div id="country_result">
                            </div>
	                  </div>
                <!--slelect shool closed-->
                <!--select class starts-->
                    <div class="select_cityform content_blue">
                            <div class="go_back">
                            <a href="javascript:void(0);" title="<?php echo $static_info['go_back'] ?>"> </a>
                            </div>
                            <input type="text" id="city" maxlength="100" name="city" placeholder="City" value="<?php if(isset($input_data['city']))echo $input_data['city']; ?>" class="textfield content_blue" data-autosize-input='{"space":10}' autocomplete="off">
                            <?php echo $static_text['we_are_located']; ?>
                            <input type="hidden" id="city_1" name="city_1" value="<?php if(isset($input_data['city_1']))echo $input_data['city_1']; ?>">
                            <div class="result_not_found"><a href="javascript:void(0);">
                                <img src="<?php echo SKIN_URL_IMAGE;?>/submit.png"></a>
                            </div>
                            <br>
                            <div id="city_result">
                            </div>
						</div>
                          <input type="hidden" name="member_type" id="member_type" value="<?php if(isset($member_type)){ echo $member_type;} ?>"  />
                          <input type="hidden" name="institution_type" id="institution_type" value="school"  />
                          
                <!--slelect class closed-->
              <?php echo form_close(); ?>                                                         <!--form closed-->
        </div>
    <!--scroll container starts-->
</div>
<!--personal details closed-->